Optimization of insulin regimen and glucose outcomes with short-term real-time continuous glucose monitoring (RT-CGM) in type 1 diabetic children with sub-optimal glucose control on multiple daily injections: The pediatric DIACCOR study.
Archives de Pédiatrie. 2019-02-01; 26(2): 95-101
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1. Arch Pediatr. 2019 Feb;26(2):95-101. doi: 10.1016/j.arcped.2018.11.010. Epub 2019
Optimization of insulin regimen and glucose outcomes with short-term real-time
continuous glucose monitoring (RT-CGM) in type 1 diabetic children with
sub-optimal glucose control on multiple daily injections: The pediatric DIACCOR
Picard S(1), Bonnemaison-Gilbert E(2), Leutenegger E(3), Barat P(4).
(1)Point Médical, Rond-Point de la Nation, 21000 Dijon, France.
(2)Tours University Hospital, Clocheville Hospital (USP), 49, boulevard Béranger,
37000 Tours, France.
(3)Margaux, 11, rue Pestalozzi, 75005 Paris, France.
(4)Unité endocrinologie et diabétologie pédiatrique, université Bordeaux, CHU
Bordeaux, 33000 Bordeaux, France. Electronic address:
BACKGROUND: The impact of 7-day real-time continuous glucose monitoring (RT-CGM)
on type 1 diabetes (T1D) management remains unknown in youths with suboptimal
control by multiple daily injections (MDI). The DIACCOR Study aimed to describe
treatment decisions and glucose outcomes after a short-term RT-CGM sequence in
METHODS: This French multicenter longitudinal observational study included T1D
youths with HbA1c>7.5% or a history of severe hypoglycemia (SH) or recurrent
documented hypoglycemia. A sensor was inserted at the study-inclusion visit, and
one of three predefined treatment changes was proposed by the investigator within
7-15 days: INT=MDI intensification, CSII=switch to continuous insulin infusion,
or ER=educational reinforcement with no change in insulin regimen and a 4-month
follow-up visit (M4) was scheduled.
RESULTS: A total of 229 children (12.2±3.5 years old) were recruited by 74
pediatricians; 12.8% had a history of SH, 22.2% had recurrent hypoglycemia.
Baseline HbA1c was 8.7±1.5% (>7.5% in 82.8%). Overall, 139 (79.4%), 19 (10.9%),
and 17 patients (9.7%) were, respectively, included in the INT, CSII, and ER
subgroups. At M4, the global incidence of SH and recurrent hypoglycemia dropped
(3.4% vs. 12.8% and 6.0% vs. 22.2%, respectively) as well as the incidence of
ketoacidosis (2.1% vs. 8.1%) or ketosis (6.9% vs. 11.4%). The HbA1c decrease was
significant overall and in the INT subgroup (adjusted difference -0.29%,
P=0.009). The satisfaction rate was≥93.0% among children.
CONCLUSION: In a real-life setting, a 1-week RT-CGM can promote treatment
optimization in youths with uncontrolled T1D resulting mostly in less acute
events. CGM acceptance may improve with new-generation sensors.
Copyright © 2018. Published by Elsevier Masson SAS.
PMID: 30642746 [Indexed for MEDLINE]